Shigefuku Shunsuke, Kudo Yujin, Yunaiyama Daisuke, Matsubayashi Jun, Park Jinho, Nagao Toshitaka, Shimada Yoshihisa, Saji Hisashi, Hagiwara Masaru, Okano Tetsuya, Kakihana Masatoshi, Kajiwara Naohiro, Ohira Tatsuo, Ikeda Norihiko
Department of Surgery, Tokyo Medical University, Tokyo, Japan.
Department of Radiology, Tokyo Medical University, Tokyo, Japan.
J Thorac Dis. 2018 Feb;10(2):973-983. doi: 10.21037/jtd.2018.01.61.
Small pulmonary nodules have been detected frequently by computed tomography (CT). Lung cancers with cavity formation are also easily detected. There are a few reports focused on the cavity wall, although cancer cells exist along the cavity wall, not inside. We evaluated the impact of cavity wall thickness on prognosis and assessed the clinicopathological features in non-small cell lung cancer (NSCLC) with cavity formation.
Between 2005 and 2011, 1,313 patients underwent complete resection for NSCLC. Of these cases, we reviewed 65 patients (5.0%) diagnosed with NSCLC with cavity formation by chest CT. We classified the patients into three groups based on the maximum cavity wall thickness, namely, ≤4 mm (Group 1, 8 patients), >4 and ≤15 mm (Group 2, 33 patients), and >15 mm (Group 3, 24 patients).
The number of patients with pathological whole tumor size >3 cm was 2 (25%) in Group 1, 17 (52%) in Group 2, and 23 (96%) in Group 3 (P<0.001). Cases with lymph node metastasis were 0 (0%) in Group 1, 5 (15%) in Group 2, and 10 (42%) in Group 3 (P=0.016). The 5-year overall survival (OS) rates were 100% in Group 1, 84.0% in Group 2, and 52.0% in Group 3, with significant differences between Group 1 and Group 3 (P=0.044) and between Group 2 and Group 3 (P=0.034). In univariate analysis, neither whole tumor size nor lymph node metastasis was a prognostic factor for OS (P=0.51, P=0.27). Only cavity wall thickness was a significant prognostic factor by multivariate analysis (P=0.009).
Maximum cavity wall thickness was an important prognostic factor in NSCLCs with cavity formation, comparable with other established prognostic factors.
计算机断层扫描（CT）已频繁检测到小的肺结节。有空洞形成的肺癌也很容易被检测到。尽管癌细胞沿空洞壁存在而非在空洞内部，但关于空洞壁的报道较少。我们评估了空洞壁厚度对预后的影响，并评估了有空洞形成的非小细胞肺癌（NSCLC）的临床病理特征。
2005年至2011年期间，1313例患者接受了NSCLC的根治性切除术。在这些病例中，我们回顾了65例（5.0%）经胸部CT诊断为有空洞形成的NSCLC患者。我们根据最大空洞壁厚度将患者分为三组，即≤4mm（第1组，8例患者）、>4且≤15mm（第2组，33例患者）和>15mm（第3组，24例患者）。
病理全肿瘤大小>3cm的患者数量在第1组为2例（25%），第2组为17例（52%），第3组为23例（96%）（P<0.001）。有淋巴结转移的病例在第1组为0例（0%），第2组为5例（15%），第3组为10例（42%）（P=0.016）。第1组的5年总生存率（OS）为100%，第2组为84.0%，第3组为52.0%，第1组和第3组之间以及第2组和第3组之间存在显著差异（P=0.044，P=0.034）。在单因素分析中，全肿瘤大小和淋巴结转移均不是OS的预后因素（P=0.51，P=0.27）。多因素分析显示，只有空洞壁厚度是显著的预后因素（P=0.009）。
最大空洞壁厚度是有空洞形成的NSCLC的重要预后因素，与其他已确定的预后因素相当。
